JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
IRON ASSASSIN'S DEMO DERBY
Event Timing: April 4th, 2020
Event Address: 33800 King Rd Abbotsford BC,
Contact us at 778-347-1159, Email:
Demoderby100@gmail.com
Sign in to Google
to save your progress.
Learn more
* Required
Email
*
Your email
FIRST & LAST NAME
*
Your answer
FULL ADDRESS & PHONE #
*
Your answer
CLASSES COMPETING IN
*
WELDED DERBY 3 PIT PASSES, FEE $225
UNWELDED DERBY 2 PIT PASSES, FEE $175
ROLLOVER STUNTS 1 PIT PASS, FEE $100
FULL SIZE TRUCK DERBY 2 PIT PASSES, FEE $125
SMALL CAR FIG 8 & TEAM DERBY 1 PIT PASS EACH DRIVER, FEE $125 (PER CAR)
VAN DERBY 1 PIT PASS, FEE $100
SMALL TRUCK DERBY 1 PIT PASS, FEE $125
ADDITIONAL PIT PASSES $25 EACH $35 DAY OF EVENT
Other:
Required
VEHICLE INFO (YR, MAKE, MODEL, ENGINE)
*
Your answer
VEHICLE #
*
Your answer
PASSENGER NAME
*
Your answer
SPONSOR INFO
*
Your answer
SMALL CAR TEAM MATE NAME, #, TEAM NAME
*
Your answer
ACCOMPLISHMENTS (TELL US ABOUT YOU)
*
Your answer
EMERGENCY CONTACT NAME #
*
Your answer
TOTAL PAYMENT: make payment by e-transfer to
demoderby100@gmail.com
, question demo, answer derby1 . CHECK PAYABLE TO LEE PEMBLE
*
YOU MUST NOTE YOUR BANK CONFIRMATION # ON THIS FORM, OR MAIL CHECK TO PO Box 824 Abbotsford B.C. Canada V2T 7A2 AND INCLUDE YOUR CHECK # ON THIS FORM (BELOW NOTE PAYMENT TYPE)
Your answer
BANK E-TRANSFER CONFIRMATION # OR CHECK #
*
Your answer
BY REGISTERING YOU AGREE TO SEND PAYMENT ASAP, ACKNOWLEDGE TO NO MINORS UNDER 14, NO ALCOHOL OR ILLEGAL DRUGS ALLOWED IN PITS OR COMPETITION AREA
*
Option 1
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms